Percutaneous cement augmentation for the treatment of depression fractures of the tibial plateau

Abstract

The management of insufficiency fractures of the tibial plateau in osteoporotic patients can be very challenging, since it is difficult to achieve a stable fixation, an essential condition for the patients' early mobilization. We present a minimally invasive technique for the treatment of proximal tibial plateau fractures, ''tibiaplasty'', using percutaneous polymethylmethacrylate augmentation. Five osteoporotic patients (7 fractures) with a non-traumatic insufficiency tibial plateau fracture were treated with this technique at the authors' institution from 2006 to 2008. The patients' median age was 79 (range 62-88) years. The intervention was performed percutaneously under general or spinal anesthesia; after the intervention, immediate full weight bearing was allowed. The technique was feasible in all patients and no complications related to the intervention were observed. All patients reported a relevant reduction in pain, were able to mobilize with full weight bearing and would undergo the operation again. No secondary loss of reduction or progression of arthrosis was observed in radiological controls; no revision surgery was required. Our initial results indicate that tibiaplasty is a good treatment option for the management of insufficiency in tibial plateau fractures in osteoporotic patients. The technique is minimally invasive, safe and allows immediate mobilization without restrictions. In our group of patients, we found excellent early to mid-term results.

Minimal-invasive, ballonassistierte Aufrichtung und innere Fixation von Tibiaplateaufrakturen

“…Gleichwohl die ballonassistierte interne Reposition und Aufrichtung von Frakturen und die perkutane Verabreichung von Knochenzement zur Stabilisierung keine neuen Techniken sind, stellt die gemeinsame Anwendung beider Verfah-ren im Bereich des Tibiaplateau ein Verfahren dar, welches erst in letzter Zeit zusehends zur Anwendung kommt [1,10,14,19,25].…”

“…Zudem steigt das Risiko für Wundheilungsstörungen, Weichteilinfektionen wie auch Pseudarthrosen. Durch perkutane Verfahren lassen sich die den Knochen umgebenden Weichteile schützen [10].…”

Osseous vitality in single photon emission computed tomography/computed tomography (SPECT/CT) after balloon tibioplasty of the tibial plateau: a case series

“…Furthermore, they recommended a minimal distance of 3 mm from the balloon to the articular surface, but in our opinion, even five millimeters are sufficient enough to elevate the impacted fragment in order to avoid subchondral or chondral exothermic damage [ 10 ]. Evangelopoulos et al [ 14 ] also reported good outcomes in seven atraumatic fractures of the tibial plateau in five osteoporotic patients. They highlighted the positive effect of minimal soft tissue damage and immediate full weight-bearing postoperatively by using pure PMMA.…”

“…It has been shown to have similar reduction capabilities as conventional mechanical tamps and can be used successfully to elevate tibial impressions [ 13 ]. Another advantage of this technique consists of the percutaneous approach without periosteal stripping/fenestration, which means a reduction in postoperative complications such as infections, delayed wound healing and pseudarthrosis [ 14 ]. Although the cement is rather expensive, it is still cheaper than other synthetic bone substitutes.…”

Arthroscopy assisted balloon osteoplasty of a tibia plateau depression fracture: A case report

“…[ 8 ] It has been found that arthroscopic assisted management of tibial plateau fractures allows early rehabilitation, short hospitals stay and low complications rate. [ 9 ] The open surgical technique demonstrated similar long term results and arthroscopy had no influence in the anatomical reduction. [ 10 11 ]…”